Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 19th June 2013

My feeble brain tries, and completely fails, to
keep up with the flow of new information on topics that interest
me. Generally, I skim through trying to get the essence of what
has been written.

But this steady stream, or raging torrent,
occasionally contains a tidal surge as a very large amount of
information gets released in one go. When that happens twice in
one week, it really becomes problematic.

Such large scale appearances are generally the
result of someone taking an entire archive and making it
available online. That just happened twice in a week. The second
was the release of 140 years of ‘Popular Science’ magazine.
‘Popular Science’ is an American magazine and it looks very like
an American version of ‘New Scientist’. By that I mean it
conveys science to the general reader but does it with much more
pizzazz, and many more adverts, than the UK publication.

The archive is fully searchable and what
little time I’ve spent with it, so far, suggests that it may
prove to be very enlightening as much because of what it doesn’t
include. But I’ll leave further consideration of ‘PopSci’, as it
refers to itself these days, for another time.

Because today I want to look at the other new
release – the complete archive of the US ‘Journal of Inebriety’.
This pdf
explains what the project is about.

Making sure one has taken account of every
piece in the new issue of a journal is hard enough. When 141
issues become simultaneously available the choice is between
telling the world you will be unavailable for a month or dipping
in at random in the hope of finding something of interest.

According to the explanation linked to, above;

‘“All of the issues can now be accessed
electronically, making it easy to look for specific topics
within the 35-volume collection,” said Hazelden Library Manager
Barbara Weiner, who spearheaded the project along with Mr.
White.’

That’s over-stating it somewhat because the
files are not electronically searchable and one has to pore
through the index to find an item that, from its title, seems
worthy of further study and then scroll through the pdf of the
issue to find it.

But, if my first serendipitous exploration is
anything to go by, that could prove to be a worthwhile, if
somewhat laborious, process.

Issue No.4 from Volume 5 published in October
1883 contains an article be Dr. J B Mattison (who was described
in 1902 as ‘medical director of the Brooklyn Home for Narcotic
inebriants’ with over thirty years’ experience with addiction
treatment) entitled ‘The Curability of Opium Addiction’. (Page
44 of this very large pdf.)

When the current UK government adopted its new
‘drugs strategy’, it said it was making treatment a much higher
priority. That sounds laudable and in line with the general
shift towards harm reduction measures for problem drug users.
Unfortunately, whether because of dogmatic adherence to the
notion of success equalling profit or because of a fear that it
would be open to press abuse for wasting money on ‘junkies’ at a
time when ‘hard-working families’ were suffering austerity
measures, it also introduced a system of payment by results for
treatment providers.

That in itself might not have been so bad had
it not decided that a ‘result’ in treatment terms meant
achieving total abstinence. Simply getting an injecting drug
user onto a maintenance programme enabling them to bring their
life into control, avoiding high-risk needle-sharing and
criminal activity to fund street purchases, is viewed as a
failure.

In the simplistic world of politics, the
individual represents the population so the fact that there are
those who have been able to achieve complete abstinence after
long periods of addiction is taken to mean that this outcome is
available to all and, for many politicians, it is also proof
that those who do not achieve complete abstinence are simply not
trying hard enough.

It was that present day issue that made Dr
Mattison’s thoughts so interesting. Mattison had been asked
whether ‘opiomania’ could be cured – whether he knew of any
well-authenticated cases of people being abstinent for ten years
or more. His answer was a most emphatic ‘Yes’.

But he then looked at what was meant by
‘cured’. Straightaway he notes that in both ‘professional and
lay circles’ there are those who say that ‘unless recovery be
never followed by relapse it is a failure’. This approach he
says is a mistake and he says that a recovered addict may well
relapse if exposed to the same conditions that brought about the
original addiction. As an example, Mattison says that a patient
who has become addicted to morphia as the result of chronic pain
is unlikely to achieve abstinence if the pain continues and
suggests that such people are ‘ineligible for treatment’.

Most of his paper relates brief case histories
from his own and other doctors’ experiences though they are all
of successful treatment producing complete abstinence.

His concluding paragraph says that opium
addiction is curable in the sense that other diseases are. But,
just as with other diseases, it is essential to ensure that the
same conditions that produced the original addiction are avoided
in the future. He also says that abstinence from alcohol is
essential to ensure that one addiction is not simply replaced by
another.

Dr Mattison is in no doubt that addiction is a
disease and that removing the cause of the original incentive to
use opium or morphine is as essential to recovery as removing
the source of a cholera outbreak is to preventing its
re-appearance.

It is slightly depressing to find that 130
years on there are still those who say that addiction should be
dealt with by criminal sanction and that, even where treatment
is recognised as the proper way to deal with it, the system
still behaves as though you can cure addiction without dealing
with its underlying causes.

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